Heart Failure. Dr. Voltaire Nadurata Clinical Director Cardiology Department

Size: px
Start display at page:

Download "Heart Failure. Dr. Voltaire Nadurata Clinical Director Cardiology Department"

Transcription

1 Heart Failure Dr. Voltaire Nadurata Clinical Director Cardiology Department

2 Introduction and diagnosis Treatment What s new in HF treatment? Atrial fibrillation

3 Heart failure definition - NHF and CSANZ Heart Failure Guideline 2018 complex clinical syndrome with typical symptoms and signs that generally occur on exertion, but can also occur at rest secondary to an abnormality of cardiac structure or function impaired ability of the heart to fill with blood at normal pressure or eject blood sufficient to fulfil the needs of the metabolising organs

4

5 Management of CHF in general practice in Australia NYHA FC for 216 patients (periods 1 and and 2014) - Taylor CJ, Valenti L, et al. AFP 45 (11), Nov NYHA FC II, 43.5% (n-94) NYHA FC I, 25% (n-54) NYHA FC III, 23.1% (n-50) NYHA FC IV, 6.9% (n-15) NYHA FC I NYHA FC II NYHA FC III NYHA FC IV

6 In-hospital mortality 4% (same as international benchmark) 30-day unadjusted mortality- 5.2% (lower than international benchmark) HFrEF 8.2% HFpEF 4.7% Readmission at 30 days 26.2% (higher than international benchmark 25%) VCOR-HF Snapshot 2017 Annual report

7 Precipitant for admission % Ischaemia 10.1 Medication non-adherence 9.6 Medication precipitating drugs 1.5 Rhythm disturbance 13.2 Infection 20.8

8 Definition of heart failure with reduced, mid-range and preserved ejection fraction ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Type of HF HFrEF (reduced) HFmrEF (mid-range) HFpEF (preserved) Criteria 1 Symptoms + Signs Symptoms + Signs Symptoms + Signs 2 LVEF < 40% LVEF 40-49% LVEF >50% 3-1. Elevated levels of natriuretic peptides 2. At least one additional criterion: a. relevant structural heart disease (LVH and/or LAE) b. diastolic dysfunction 1. Elevated levels of natriuretic peptides 2. At least one additional criterion: a. relevant structural heart disease (LVH and/or LAE) b. diastolic dysfunction

9 Heart failure diagnostic criteria - NHF and CSANZ Heart Failure Guideline 2018 HFrEF Symptoms +/- signs of heart failure HFpEF Symptoms +/- signs of heart failure LVEF < 50% LVEF > 50% Objective evidence of: - Structural heart disease (LVH, LAE) and/or - Diastolic dysfunction, with high filling pressure demonstrated by any of the following: cardiac cath, echo, BNP/NT probnp, exercise test

10 Vicious Cycle of heart failure pathophysiology - NHF and CSANZ HF guidelines 2011

11 Typical trajectory of illness in CHF compared to terminal malignancy - NHF and CSANZ HF guideline 2011

12 Severity of Heart FailureModes of Death - MERIT-HF Study Group. LANCET. 1999;353: NYHA II (n-103) NYHA III (n-103) 12% CHF 26% CHF 24% Other 59% Other 64% Sudden Death 15% Sudden Death NYHA IV (n-27) 33% 56% CHF Other 11% Sudden Death

13 Drivers and potential targets for treatment in heart failure with reduced EF - NHF and CSANZ HF guidelines 2018

14 Signs and symptoms of heart failure - NHF and CSANZ HF guidelines 2018

15 Step by step assessment of NYHA FCs - National Heart Foundation. Congestive Heart Failure Guideline Any Yes 1. Can you walk down a flight of steps without stopping? Go to 2 Go to 4 2. Can you carry something up a flight of 8 steps with stopping? Or can you: a) Have sexual intercourse without stopping? b) Garden, rake, weed? c) Walk at 6km/hour on level ground? 3. Can carry at least 10 kgs up 8 steps? Or can you: a) Carry objects that are at least 36 kgs? b) Ski, play basketball, squash? 4. Can you shower without stopping? Or can you: a) Mop floors? b) Hang out wet clothes? c) Clean windows? d) Walk 4 km/hour? e) Play golf, walk and carry clubs? f) Push power lawn mower? Go to 3 Class I No Class III Class II Class III Go to 5 5. Can you dress without stopping? Class III Class IV

16 Diagnostic workup of a patient suspected of heart failure - NHF and CSANZ HF guidelines 2018

17 Imaging in Heart Failure Transthoracic Echocardiography Transoesophageal Echocardiography Stress Echocardiography Contrast echo and strain imaging echocardiography Cardiac MRI Cardiac CT Nuclear imaging

18 LV dimension Ejection fraction Valvular abnormalities

19 Stress Echocardiography Used for assessment of flow limiting coronary artery disease Functional capacity testing Cardiac arrhythmia Invasive coronary angiography will be required if wall motion abnormality or exercise induced LV systolic dysfunction

20 Transeosphageal Echocardiography Useful in patient with poor transthoracic echo image quality Assessment for other abnormalities constrictive pericarditis intracardiac shunt intracardiac thrombus mitral regurgitation severity and mechanism

21 Coronary angiogram and cardiac catheterisation

22 Other imaging modalities CT coronary angiography non-invasive assessment of coronary arteries issue with radiation and image quality Cardiac MRI Highly specialized test LV function and structural heart disease No radiation Nuclear imaging myocardial perfusion scan gated heart pool scan to assess LV systolic function

23 Other diagnostic tests BNP and NTproBNP prognostic value most powerful predictors of mortality and adverse CV outcome clinical impact and change in management is uncertain Genetic testing cardiomyopathy associated with conduction disease

24 Introduction and diagnosis Treatment What s new in HF treatment? Atrial fibrillation

25 Beta-blockers ACE-inhibitors or Angiotensin receptor blocker Mineralocorticoid antagonist ARNI Hydralazine and nitrates Digoxin Diuretics Cardiac implantable electrical devices

26 Basis for beta-blocker usage in heart failure Upregulation of Beta receptors Direct myocardial protective action against cathecolamine toxicity Antiarrhythmic effects Increase coronary blood flow by reducing heart rate and improving diastolic perfusion time Vasodilation Prevention of ventricular muscle hypertrophy and vascular remodelling

27 Beta-blockers for HFrEF - ACC/AHA Heart failure guidelines 2014 Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in Clinical Trials Beta Blockers Bisoprolol 1.25 mg once 10 mg once 8.6 mg/d Carvedilol mg twice 50 mg twice 37 mg/d Nebivolol 1.25mg once 10 mg once Metoprolol succinate extended release (metoprolol CR/XL) mg once 190 mg once 159 mg/d

28 Properties of beta blockers with evidence on treatment of heart failure Bisoprolol Carvedilol Metoprolol Nebivolol Β1-selectivity Yes No Yes Yes Peripheral vasodilation No Yes No Yes Antioxidant effect No Yes No No Nitric Oxide release No No No Yes Drugs Aging 2007; 24 (12):

29 Beta-blockers practice advise - NHF and CSANZ HF guidelines 2018 Ensure that the patient is clinically stable and euvolaemic before commencing beta blockers. Commenced after starting ACE inhibitors (or ARBs); however, if the patient is euvolaemic, they may be commenced before starting ACE inhibitors (or ARBs) Started at low doses and gradually uptitrated by doubling the dose every 2 4 weeks, aiming for target doses or maximum tolerated doses Patients should be reviewed following initiation and each dose escalation with monitoring of heart rate, blood pressure, and clinical evaluation of volume status at 1 2 weeks and 6- monthly long term Uptitration of beta blockers should not be to the detriment of starting other drugs that have been shown to decrease mortality in patients with HFrEF If the patient develops symptomatic bradycardia (<50 bpm), arrange an ECG to document the rhythm and review the need for other drugs lower heart rate If the patient develops symptomatic hypotension, assess volume status and review the need for other drugs not shown to improve outcomes in heart failure that lower blood pressure If the patient develops increasing congestion, this can usually be managed by increasing the diuretic dose, but occasionally may require a reduction in the beta blocker dose

30 ACE Inhibition and Angiotensin receptor blockade Reduce angiotensin II vasoconstriction Normalize peripheral vascular structure Improve endothelial dysfunction Reduce levels of circulating endothelin Reduce smooth muscle mass

31 ACE inhibitors and ARBs for HFrEF - ACC/AHA Heart failure guidelines 2014 Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in Clinical Trials ACE Inhibitors Captopril 6.25 mg 3 times 50 mg 3 times mg/d Enalapril 2.5 mg twice 10 to 20 mg twice 16.6 mg/d Fosinopril 5 to 10 mg once 40 mg once Lisinopril 2.5 to 5 mg once 20 to 40 mg once 32.5 to 35.0 mg/d Perindopril 2 mg once 8 to 16 mg once Quinapril 5 mg twice 20 mg twice Ramipril 1.25 to 2.5 mg once 10 mg once Trandolapril 1 mg once 4 mg once ARBs Candesartan 4 to 8 mg once 32 mg once 24 mg/d Losartan 25 to 50 mg once 50 to 150 mg once 129 mg/d Valsartan 20 to 40 mg twice 160 mg twice 254 mg/d

32 ACE inhibitors and ARB practice advise - NHF and CSANZ HF guidelines 2018 ACE inhibitors are started at low doses and uptitrated by doubling the dose every two weeks, aiming for target or maximum tolerated doses. Patients should be reviewed following initiation and each dose increase with monitoring of BP and biochemistry (renal function, potassium) at 1 2 weeks and 6-monthly long term. Uptitration of ACE inhibitors should not be to the detriment of starting other drugs that have been shown to decrease mortality in patients with HFrEF. Small rises in serum creatinine and asymptomatic falls in blood pressure are common following the of ACE inhibitors. doses commencement If the patient develops symptomatic hypotension, the egfr decreases by more than 30%, or the K rises above 5.5 mmol/l, the volume status should be assessed and the need for other drugs not shown to improve outcomes in heart failure that lower blood pressure or impact on renal function and potassium should be reviewed. If the patient develops angioedema, ACE inhibitor ceased, and specialist advice sought. If the patient develops a cough, one should consider whether this is due to pulmonary congestion or lung disease. If it is felt likely that the cough is related to the ACE inhibitor is interfering with the patient s quality of life, the ACE inhibitor may be changed to an ARB.

33 Diuretics First line usually frusemide and up titrate dependent on the blood pressure and renal function. Hyponatraemia is independent predictor of poor outcome Mineralocortoid receptor antagonists (MRA) Spironolactone Eplerenone

34 Mineralocorticoid antagonists Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in Clinical Trials Aldosterone Antagonists Spironolactone 12.5 to 25 mg once 25 mg once or twice 26 mg/d Eplerenone 25 mg once 50 mg once 42.6 mg/d ACC/AHA Heart failure guidelines 2014

35 Spironolactone RALES - Randomized Aldactone Evaluation Study 30% reduction in all-cause death 31% decrease in death from cardiac causes 30% reduction in hospitalizations for cardiac causes significant improvement in NYHA functional class. * very few patients were taking beta blockers Szady AD, Hill JA. Drugs 2009; 69 (17):

36 Eplerenone EPHESUS - Eplerenone Post-AMI Heart Failure Efficacy Survival Study * AMI within 3 14 days of randomization statistically significant decreases death from any cause death from cardiovascular causes 21% reduction in the rate of sudden death hospitalizations for cardiovascular events 23%reduction in the number of hospitalizations for heart failure Szady AD, Hill JA. Drugs 2009; 69 (17):

37 Diuretic resistance - Szady AD, Hill JA. Drugs 2009; 69 (17): braking phenomenon in acute setting, kidney maintains a neutral sodium balance once the diuretic is no longer at therapeutic concentration, sodium reabsorption is stimulated and a new steady state is achieved where the same amount of diuretic induces less natriuresis and diuresis increased sodium delivery over time to the distal tubule stimulates hypertrophy of these cells and their increased reabsorption of sodium activation of the RAAS

38 Diuretic Resistance clinical strategy for diuretic use - Szady AD, Hill JA. Drugs 2009; 69 (17): acute decompensated heart failure low sodium diet may lessen braking phenomenon continuous infusion chronic heart failure intermittent dosing higher doses to overcome the decreased secretion into the proximal tubule due to decreased renal blood flow switching to bumetanide due to its higher bioavailability combining the use of loop and thiazide diuretics blockade of RAAS with ACE inh and aldosterone antagonists

39 ACE inhibitors and ARB practice advise - NHF and CSANZ HF guidelines 2018 MRAs should be avoided or used cautiously in patients with stage 4 or 5 chronic kidney disease or serum potassium above 5 mmol/l. Patients should be instructed to avoid foods high in potassium and potassium supplements Low doses are prescribed, starting with 25 mg daily for spironolactone or eplerenone and uptitrating in 4 8 weeks, aiming for target doses of 50 mg daily spironolactone or eplerenone. Patients should be reviewed following initiation and each dose escalation with monitoring of blood pressure and blood biochemistry at 1 2 weeks, then every 4 weeks for 12 weeks, at 6 months and then 6-monthly If the egfr decreases by more than 30% or the serum potassium rises above 5.5 mmol/l, assess volume status and review the need for other drugs that affect renal function and potassium If the serum potassium rises above 6.0 mmol/l, the MRA should be ceased Patients who develop gynaecomastia on spironolactone may be switched to eplerenone.

40 ARNI angiotensin receptor neprilysin inhibitor New drug on the market at the moment Stopped early due to the finding of both significantly reduced risk of CV death vs. enalapril (HR: 0.80, p<0.001) and the primary endpoint being met Needs a washout period of 36 hours if from ACEi Based on the previous ACEi/ARB will dictate the dose that it is started on. Gradual increase in dose over a period of 2 weeks

41 The SNS and RAAS are over-activated in HF and are responsible for many of the pathophysiological responses that contribute to disease progression SNS HEART FAILURE SYMPTOMS & PROGRESSION Adrenaline Noradrenaline α 1, β 1, β 2 receptors Vasoconstriction RAAS activity Vasopressin Heart rate Contractility RAAS Ang II AT 1 R Vasoconstriction Blood pressure Sympathetic tone Aldosterone Hypertrophy Fibrosis

42 Secretion of natriuretic peptides results in a number of responses that act to reduce the symptoms and progression of HF NP system NPRs NPs Vasodilation Blood pressure Sympathetic tone Natriuresis/diuresis Vasopressin Aldosterone Fibrosis Hypertrophy INACTIVE FRAGMENTS HEART FAILURE SYMPTOMS & PROGRESSION

43 Imbalance in these key neurohormonal systems drives HF progression Pathologic activation ARB - valsartan RAAS SNS Natriuretic peptide system e.g. ANP, BNP, CNP Compensatory activation sodium/water retention and BP Vasoconstriction cardiac output Cardiac and vascular hypertrophy Blood vessel dilation (vasodilation) sodium/water excretion Fibrosis inhibition Inhibition of aldosterone release Sacubitril neprilysin inhibitor Persistent pathophysiological HF progression

44 ARNI angiotensin receptor neprilysin inhibitor - NHF and CSANZ HF guidelines 2018 Recommended as a replacement for an ACE inhibitor or an ARB in patients with HFrEF associated with an LVEF of less than or equal to 40% despite receiving maximally tolerated or target doses of an ACE inhibitor (or ARB) and a beta blocker (unless contraindicated), with or without an MRA, to decrease mortality and decrease hospitalisation.

45 ARNI practice advise - NHF and CSANZ HF guidelines 2018 Ensure that ACE inhibitors are stopped at least 36 hours before commencing Start at a low or moderate doses and uptitrated by doubling the dose every 2 4 weeks, aiming for target doses or maximum tolerated doses Reviewed following initiation and each dose escalation with monitoring of blood pressure and blood biochemistry (renal function and potassium) at 1 2 weeks and 6- monthly long term Uptitration of ARNIs should not be to the detriment of starting other drugs (beta blockers and MRAs) that have been shown to decrease mortality in patients with HFrEF Small rises in serum creatinine and asymptomatic falls in blood pressure are common following the commencement. If the patient develops symptomatic hypotension, the egfr decreases by more than 30% or the serum K rises above 5.5 mmol/l, assess volume status and review the need for other drugs that lower blood pressure or affect renal function and K If the patient develops angioedema, this should be managed, the ARNI should be ceased

46 Ivabradine Act specifically on the sinus node, by selective inhibition of the I f current Has no impact on atrioventricular conduction or QT interval, no negative inotropic properties, no effect on blood pressure or the electrophysiological properties of the heart and can be safely coadministered with other therapies including beta-blockers Potent anti-anginal agent Steg P G Eur Heart J Suppl 2010;12:C11-C15

47 Ivabradine practice advise - NHF and CSANZ HF guidelines 2018 Should be considered in patients with HFrEF associated with an LVEF of less than or equal to 35% and with a sinus rate of 70 bpm and above despite receiving maximally tolerated or target doses of an ACE I inhibitor (or ARB) and a beta blocker (unless contraindicated), with or without an MRA, to decrease the combined endpoint of cardiovascular mortality and hospitalisation for heart failure.

48 Ivabradine practice advise - NHF and CSANZ HF guidelines 2018 Ensure patients are on maximally tolerated or target doses of beta blockers (unless contraindicated) If sinus rate is 70 bpm or above despite maximally tolerated or target doses of beta blockers (unless contraindicated), ivabradine should be considered Start at mg twice daily and uptitrate by doubling the dose every 2 4 weeks, aiming for a target dose of 7.5 mg twice daily or the maximum tolerated dose. Patients should be reviewed following initiation and each dose escalation with monitoring of heart rate at 1 2 weeks and 6-monthly long term. Aim for a sinus rate between 50 and 60 bpm Prescribing and uptitration of ivabradine should not be to the detriment of starting other drugs that have been shown to decrease mortality in patients with HFrEF If the patient develops symptomatic bradycardia or asymptomatic bradycardia below 50 bpm, arrange an ECG to document the rhythm and review the need for other drugs that lower heart rate (e.g., digoxin and amiodarone). If the patient develops persistent or permanent AF, cease ivabradine and review the need for ivabradine if and when the patient reverts to sinus rhythm

49 Hydralazine plus Nitrates practice advise - NHF and CSANZ HF guidelines 2018 Hydralazine plus nitrates may be considered in patients in whom ACE inhibitors and ARBs are contraindicated or not tolerated, and in patients with refractory moderate or severe symptoms despite best practice therapy Low doses of hydralazine (25 mg three times daily) plus nitrates (isosorbide dinitrate 20 mg three times daily or isosorbide mononitrate 60 mg once daily) are usually started and uptitrated over two to four weeks, aiming for target doses of hydralazine (50 75 mg three times daily) plus nitrates (isosorbide dinitrate 60 mg three times daily or isosorbide mononitrate 120 mg once daily) or maximum tolerated doses Review following initiation and each dose escalation with monitoring of blood pressure at 1 2 weeks and 6-monthly long term Prescribing and uptitration of hydralazine plus nitrates should not be to the detriment of starting other drugs that have been shown to decrease mortality in patients with HFrEF If the patient develops symptomatic hypotension, assess volume status and review the need for other drugs that lower blood pressure (e.g., calcium channel blockers, diuretics).

50 Digoxin No effect on mortality in heart failure. May be useful for maintaining clinical stability and exercise capacity in patients with symptomatic heart failure. Second-line drug after diuretics, angiotensin-converting enzyme inhibitors and β-blockers in patients with congestive heart failure who are in sinus rhythm. First-line drug in patients with congestive heart failure who are in atrial fibrillation. Campbell TJ, MacDonald PS. MJA 2003; 179 (2):

51 Optimal dosing for digoxin Low serum digoxin concentrations reduces HF mortality HF hospitalizations < or = mg/ day Ahmed A, Pitt B, Braunwald E, et al. Int J Cardiol Jan; 123 (2),

52 HFrEF Management Algorithm - NHF and CSANZ HF guidelines 2018

53 Treatment of Heart Failure With Recovered Ejection Fraction - NHF and CSANZ HF guidelines 2018 Cardiac function may not be normal despite a normal LVEF, with in patients with a normal LVEF. Recovery is likely to represent remission rather than cure in most cases persistent abnormalities in biomarkers, abnormal functional capacity, and poor contractile reserve Three small clinical trials of beta blocker withdrawal iwere associated with decreases in EF, and recurrence of heart failure and deaths; a retrospective study identified cessation of heart failure medications as the only predictor of recurrence in heart failure with recovered EF Unless a reversible cause has been corrected, medications should be continued at target doses in patients with heart failure to decrease the risk of recurrence Loop diuretics and thiazides may be weaned and ceased as tolerated

54 Follow-up 7-14 days following discharge (OPTIMISE-HF: associated with significant reduction in readmission) frequency should be guided by clinical state Self-management patient and carer education patient centred revised as required and literacy guided taking right meds at right dose and time monitoring of signs and symptoms collaboration with health professionals - NHF and CSANZ HF guidelines 2018

55 Fluid restriction for patients with overt congestion, restrict to 1.5L/day if weight increases by 2kg in 2 days, see doctor and consider increase in diuretic sliding scale of diuretics for competent patients Sodium intake no clear evidence consensus recommendation is to follow NHF guideline of <2g/day Exercise training continuous endurance training resistance training may be more beneficial for advance HF - NHF and CSANZ HF guidelines 2018

56 Introduction and diagnosis Treatment Acute heart failure What s new in HF treatment? Atrial fibrillation

57 Cause of acute decompensation of chronic heart failure - NHF and CSANZ HF guidelines 2018 Acute MI or ischemia Arrhythmia (AF, VT) Infection (respiratory, endocarditis) Anaemia Thyroid disorder Increased sympathetic drive (acute hypertension, pheochromocytoma, takotsubo cardiomyopathy) Acute renal failure Hypoxia (pneumonia, PE) Noncompliance with medications, fluid, salt restriction Pericardial tamponade Drugs that may worsen heart failure Adrenal insufficiency or steroid excess Mechanical issue (myocardial rupture, acute valve regurgitation

58

59

60 CRT (with or without an ICD) - NHF and CSANZ HF guidelines 2018 Should be considered for patients with heart failure associated with an LVEF of less than or equal to 35% and a QRS duration of 130 ms or more despite optimal medical therapy The benefit of CRT is greater in patients with a broader QRS duration (especially QRS duration 150 ms) Other factors that may influence decision-making If CRT is performed in patients in AF, measures are required to ensure at least 92% biventricular capture

61 Implantable Cardiac Defibrillator - NHF and CSANZ HF guidelines 2018 Generally single-chamber ICDs are recommended with an atrial lead included only if there is a separate bradycardia indication CRT should also be considered in patients with HFrEF associated with a QRS duration of 130 ms or more and an LVEF of less than or equal to 35% Multicenter Automatic Defibrillator Implantation Trial Reduce Inappropriate Therapy (MADIT-RIT) study demonstrated the importance of programming with a reduction in inappropriate ICD therapy and total mortality with device therapies delivered at ventricular rates of more than 200 bpm or with a 60-second delay for rates of more than 170 bpm Device programming for bradycardia parameters should be at a lower rate of 40 bpm, to minimise ventricular pacing Subcutaneous ICDs may be considered in younger people for primary prevention, however, do not provide antita- chycardia pacing or bradyarrhythmia pacing support

62

63 Remote monitor network within 3-5 metre distance area where patient spend at least 3 minutes at home

64

65

66

67 SCRAM - Smartphone Cardiac Rehabilitation Assisted self-management intervention

68 AF and Heart Failure - NHF and CSANZ HF guidelines 2018 Under-recognised reversible cause of HFrEF, particularly in patients who present with both conditions in the absence of other identifiable causes Common in patients with heart failure prevalence ranges from 5% in FC I up to 50% in FC IV, with annual incidence of 2 5% Common precipitant of heart failure, and conversely, heart failure is the strongest predictor for AF, and AF can result in myocardial dysfunction and heart failure [399]. Combination of loss of the atrial kick and irregular fast heart rhythm can reduce the cardiac output by up to 30% Although a randomised comparison of rate compared with rhythm control using pharmacological strategies in AF in HFrEF did not demonstrate superiority, this has been challenged by catheter ablation studies.

69 Anticoagulation is recommended AF and Heart Failure - NHF and CSANZ HF guidelines 2018 Pharmacological therapy for rate control aiming for a resting ventricular rate of bpm Reversion to normal sinus rhythm for rhythm control Catheter ablation for AF (either paroxysmal orpersistent) should be considered who present with recurrent symptomatic AF

70 Treatment options Anticoagulation imperative Electrical cardioversion Anti-arrhythmic therapy Beta-blockers Amiodarone Digoxin

71 Pulmonary vein Isolation procedure Ablate & pace

72 Acute rate control of AF with rapid ventricular response - NHF and CSANZ AF guideline 2018

73 Chronic rate control of AF with rapid ventricular response - NHF and CSANZ AF guideline 2018

74 Long-term rhythm control strategy - NHF and CSANZ AF guideline 2018

75

76

77 Bendigo Health Comprehensive cardiac care Community health care HARP Cardiac rehabilitation Palliative Care Cardiologist Cardiac Liaison nurse

78 Clinical pathways Murray PHN

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this

More information

Checklist for Treating Heart Failure. Alan M. Kaneshige MD, FACC, FASE Oklahoma Heart Institute

Checklist for Treating Heart Failure. Alan M. Kaneshige MD, FACC, FASE Oklahoma Heart Institute Checklist for Treating Heart Failure Alan M. Kaneshige MD, FACC, FASE Oklahoma Heart Institute Novartis Disclosure Heart Failure (HF) a complex clinical syndrome that arises secondary to abnormalities

More information

State-of-the-Art Management of Chronic Systolic Heart Failure

State-of-the-Art Management of Chronic Systolic Heart Failure State-of-the-Art Management of Chronic Systolic Heart Failure Michael McCulloch, MD 17 th Annual Cardiovascular Update Intermountain Medical Center December 16, 2017 Disclosures: I have no financial disclosures

More information

Guideline-Directed Medical Therapy

Guideline-Directed Medical Therapy Guideline-Directed Medical Therapy Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation OPTIMAL THERAPY (As defined in

More information

Summary/Key Points Introduction

Summary/Key Points Introduction Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification

More information

Heart Failure Clinician Guide JANUARY 2016

Heart Failure Clinician Guide JANUARY 2016 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.

More information

ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure Patients t with acute heart failure frequently develop chronic heart failure Patients with chronic heart failure frequently decompensate acutely ESC Guidelines for the Diagnosis and A clinical response

More information

1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure?

1/4/18. Heart Failure Guideline Review and Update. Disclosure. Pharmacist Objectives. Pharmacy Technician Objectives. What is Heart Failure? Disclosure Heart Failure Guideline Review and Update I have had no financial relationship over the past 12 months with any commercial sponsor with a vested interest in this presentation. Natalie Beiter,

More information

Heart Failure Treatments

Heart Failure Treatments Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden

More information

Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham

Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham Diagnosis and management of Chronic Heart Failure in 2018: What does NICE say? PCCS Meeting Issues and Answers Conference Nottingham NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Chronic heart failure

More information

Combination of renin-angiotensinaldosterone. how to choose?

Combination of renin-angiotensinaldosterone. how to choose? Combination of renin-angiotensinaldosterone system inhibitors how to choose? Karl Swedberg Professor of Medicine Sahlgrenska Academy University of Gothenburg karl.swedberg@gu.se Disclosures Research grants

More information

Heart Failure Clinician Guide JANUARY 2018

Heart Failure Clinician Guide JANUARY 2018 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.

More information

Heart Failure (HF) Treatment

Heart Failure (HF) Treatment Heart Failure (HF) Treatment Heart Failure (HF) Complex, progressive disorder. The heart is unable to pump sufficient blood to meet the needs of the body. Its cardinal symptoms are dyspnea, fatigue, and

More information

Heart Failure. GP Update Refresher 18 th January 2018

Heart Failure. GP Update Refresher 18 th January 2018 GP Update Refresher 18 th January 2018 Heart Failure Dr. Alexander Lyon Senior Lecturer and Consultant Cardiologist Clinical Lead in Cardio-Oncology Royal Brompton Hospital, London UK President of British

More information

2016 Update to Heart Failure Clinical Practice Guidelines

2016 Update to Heart Failure Clinical Practice Guidelines 2016 Update to Heart Failure Clinical Practice Guidelines Mitchell T. Saltzberg, MD, FACC, FAHA, FHFSA Medical Director of Advanced Heart Failure Froedtert & Medical College of Wisconsin Stages, Phenotypes

More information

HEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D

HEART FAILURE PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D HEART FAILURE PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Understand the effects of heart failure in the body

More information

A patient with decompensated HF

A patient with decompensated HF A patient with decompensated HF Professor Michel KOMAJDA University Pierre & Marie Curie Pitie Salpetriere Hospital Department of Cardiology Paris (France) Declaration Of Interest 2010 Speaker : Servier,

More information

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 3/2/2014 HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center March 2014 Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading

More information

Antialdosterone treatment in heart failure

Antialdosterone treatment in heart failure Update on the Treatment of Chronic Heart Failure 2012 Antialdosterone treatment in heart failure 전남의대윤현주 Chronic Heart Failure Prognosis of Heart failure Cecil, Text book of Internal Medicine, 22 th edition

More information

Heart Failure Medical and Surgical Treatment

Heart Failure Medical and Surgical Treatment Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February

More information

Heart Failure: Combination Treatment Strategies

Heart Failure: Combination Treatment Strategies Heart Failure: Combination Treatment Strategies M. McDonald MD, FRCP State of the Heart Symposium May 28, 2011 None Disclosures Case 69 F, prior MIs (LV ejection fraction 25%), HTN No demonstrable ischemia

More information

Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials -

Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials - Understanding and Development of New Therapies for Heart Failure - Lessons from Recent Clinical Trials - Clinical trials Evidence-based medicine, clinical practice Impact upon Understanding pathophysiology

More information

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018

Disclosure Statement. Heart Failure: Refreshers and Updates. Objectives. CHF: Chronic Heart Failure. Definitions. Definitions 2/19/2018 Disclosure Statement Heart Failure: Refreshers and Updates Tracy K. Pettinger, PharmD Clinical Associate Professor College of Pharmacy The planners and presenter of this presentation have disclosed no

More information

Therapeutic Targets and Interventions

Therapeutic Targets and Interventions Therapeutic Targets and Interventions Ali Valika, MD, FACC Advanced Heart Failure and Pulmonary Hypertension Advocate Medical Group Midwest Heart Foundation Disclosures: 1. Novartis: Speaker Honorarium

More information

Heart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist

Heart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE

More information

RAAS blocker + B Blocker Troubleshooting

RAAS blocker + B Blocker Troubleshooting RAAS blocker + B Blocker Troubleshooting Heart Failure ECHO Clinic Virtual Heart Failure Consultation and Education Prof Ken McDonald & Dr. Patricia Campbell 13 th March 2017 HF activates 3 neurohormonal

More information

Akash Ghai MD, FACC February 27, No Disclosures

Akash Ghai MD, FACC February 27, No Disclosures Akash Ghai MD, FACC February 27, 2015 No Disclosures Epidemiology Lifetime risk is > 20% for American s older than 40 years old. > 650,000 new cases diagnosed each year. Incidence increases with age: 2%

More information

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 10/5/2015. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 10/5/2015. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among

More information

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan

Outline. Classification by LVEF Conventional Therapy New Therapies. Ivabradine Sacubitril/valsartan New Pharmacological Therapies for Heart Failure Mark Drazner, MD, MSc Clinical Chief of Cardiology Medical Director, CHF/VAD/Transplant James M. Wooten Chair in Cardiology UT Southwestern Medical Center

More information

Heart Failure: Guideline-Directed Management and Therapy

Heart Failure: Guideline-Directed Management and Therapy Heart Failure: Guideline-Directed Management and Therapy Guideline-Directed Management and Therapy (GDMT) was developed by the American College of Cardiology and American Heart Association to define the

More information

Heart Failure in 2012 with reference to NICE Guidance Dr Maurice Pye Consultant Cardiologist York District Hospital

Heart Failure in 2012 with reference to NICE Guidance Dr Maurice Pye Consultant Cardiologist York District Hospital Heart Failure in 2012 with reference to NICE Guidance 2010 Dr Maurice Pye Consultant Cardiologist York District Hospital A little over elaborate,do not include ECG or CXR If clinical suspicion is high

More information

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure

ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure ESC Guidelines for the Diagnosis and Treatment of Chronic Heart Failure - 2005 Karl Swedberg Professor of Medicine Department of Medicine Sahlgrenska University Hospital/Östra Göteborg University Göteborg

More information

The Failing Heart in Primary Care

The Failing Heart in Primary Care The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and

More information

Innovation therapy in Heart Failure

Innovation therapy in Heart Failure Innovation therapy in Heart Failure P. Laothavorn September 2015 Topics of discussion Basic Knowledge about heart failure Standard therapy New emerging therapy References: standard Therapy in Heart Failure

More information

Optimal blockade of the Renin- Angiotensin-Aldosterone. in chronic heart failure

Optimal blockade of the Renin- Angiotensin-Aldosterone. in chronic heart failure Optimal blockade of the Renin- Angiotensin-Aldosterone Aldosterone- (RAA)-System in chronic heart failure Jan Östergren Department of Medicine Karolinska University Hospital Stockholm, Sweden Key Issues

More information

HEART FAILURE: PHARMACOTHERAPY UPDATE

HEART FAILURE: PHARMACOTHERAPY UPDATE HEART FAILURE: PHARMACOTHERAPY UPDATE 3 HEART FAILURE REVIEW 1 5.1 million x1.25 = 6.375 million 40 years old = MICHAEL F. AKERS, PHARM.D. CLINICAL PHARMACIST CENTRACARE HEALTH, ST. CLOUD HOSPITAL HF Diagnosis

More information

Heart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)

Heart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea) Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types

More information

Estimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches

Estimated 5.7 million Americans with HF. 915, 000 new HF cases annually, HF incidence approaches Heart Failure: Management of a Chronic Disease Jenny Bauerly RN, CHFN, APRN-BC Heart Failure (HF) Definition A complex clinical syndrome that can result from any structural or functional cardiac disorder

More information

Updates in Congestive Heart Failure

Updates in Congestive Heart Failure Updates in Congestive Heart Failure GREGORY YOST, DO JOHNSTOWN CARDIOVASCULAR ASSOCIATES 1/28/2018 Disclosures Edwards speaker on Sapien3 valves (TAVR) Stages A-D and NYHA Classes I-IV Stage A: High risk

More information

The ACC Heart Failure Guidelines

The ACC Heart Failure Guidelines The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA

More information

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor

LCZ696 A First-in-Class Angiotensin Receptor Neprilysin Inhibitor The Angiotensin Receptor Neprilysin Inhibitor LCZ696 in Heart Failure with Preserved Ejection Fraction The Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection

More information

ACE inhibitors: still the gold standard?

ACE inhibitors: still the gold standard? ACE inhibitors: still the gold standard? Session: Twenty-five years after CONSENSUS What have we learnt about the RAAS in heart failure? Lars Køber, MD, D.Sci Department of Cardiology Rigshospitalet University

More information

Treating HF Patients with ARNI s Why, When and How?

Treating HF Patients with ARNI s Why, When and How? Treating HF Patients with ARNI s Why, When and How? 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La Jolla, CA Barry Greenberg M.D. Distinguished Professor

More information

Definition of Congestive Heart Failure

Definition of Congestive Heart Failure Heart Failure Definition of Congestive Heart Failure A clinical syndrome of signs & symptoms resulting from the heart s inability to supply adequate tissue perfusion. CHF Epidemiology Affects 4.7 million

More information

Heart Failure A Disease for the Internist?

Heart Failure A Disease for the Internist? Heart Failure A Disease for the Internist? Dr Chris Davidson Sussex Cardiac Centre BRIGHTON UK Hot Topics in Heart Failure Drug treatments Valsartan / neprilysin inhib Investigations BNP and others Devices

More information

Heart Failure: Current Management Strategies

Heart Failure: Current Management Strategies Heart Failure: Current Management Strategies CSHP Fall Education Session- September 30th, 2017 Carolyn MacKinnon & Tamara Matchett BscPharm, ACPR Candidates Objectives 1. Describe the pathophysiology &

More information

Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary

Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1 Indication Entresto Reduce the risk of cardiovascular (sacubitril/valsartan) death

More information

HEART FAILURE SUMMARY. and is associated with significant morbidity and mortality. the cornerstone of heart failure treatment.

HEART FAILURE SUMMARY. and is associated with significant morbidity and mortality. the cornerstone of heart failure treatment. HEART FAILURE SUMMARY + Heart Failure is a condition affecting a large number of Irish people and is associated with significant morbidity and mortality. + ACE inhibitors, in combination with diuretics,

More information

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group

From PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF

More information

Heart Failure CTSHP Fall Seminar

Heart Failure CTSHP Fall Seminar Heart Failure CTSHP Fall Seminar Laurajo Ryan, PharmD, MSc, BCPS, CDE Pharmacist Learning Objectives Outline the pathophysiology of heart failure List triggers for decompensated heart failure Describe

More information

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction

Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Cardio-Metabolic Franchise Entresto Development of sacubitril/valsartan (LCZ696) for the treatment of heart failure with reduced ejection fraction Randy L Webb, PhD Rutgers Workshop October 21, 2016 Heart

More information

Beyond ACE-inhibitors for Heart Failure. Jacob Townsend, MD NCVH Birmingham 2015

Beyond ACE-inhibitors for Heart Failure. Jacob Townsend, MD NCVH Birmingham 2015 Beyond ACE-inhibitors for Heart Failure Jacob Townsend, MD NCVH Birmingham 2015 % Decrease in Mortality Current Therapy HFrEF 0% Angiotensin receptor blocker ACE inhibitor Beta blocker Mineralocorticoid

More information

Introduction to Heart Failure. Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL

Introduction to Heart Failure. Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL Introduction to Heart Failure Mauricio Velez, M.D. Transplant Cardiologist APACVS 2018 April 5-7 Miami, FL Disclosures No relevant financial relationships to disclose Objectives and Outline Define heart

More information

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 2/20/2017. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center

HEART FAILURE. Heart Failure in the US. Heart Failure (HF) 2/20/2017. Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center HEART FAILURE Martina Frost, PA-C Desert Cardiology of Tucson Northwest Medical Center Heart Failure in the US Prevalence - ~5 million 650,000 new cases annually 300,000 deaths annually Leading DRG among

More information

Contemporary Management of Heart Failure. Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium

Contemporary Management of Heart Failure. Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium Contemporary Management of Heart Failure Keerthy K Narisetty, MD Comprehensive Heart Failure Management Program BHHI Primary Care Symposium Disclosures I have no relevant relationships with commercial

More information

Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF<40%

Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF<40% Evaluation and Management of Acute Decompensated Heart Failure (HF) with Reduced Ejection Fraction Systolic Heart Failure (HFrEF)(EF

More information

Management Strategies for Advanced Heart Failure

Management Strategies for Advanced Heart Failure Management Strategies for Advanced Heart Failure Mary Norine Walsh, MD, FACC Medical Director, HF and Cardiac Transplantation St Vincent Heart Indianapolis, IN USA President American College of Cardiology

More information

MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION

MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION MEDICAL MANAGEMENT OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION FRANCIS X. CELIS, D.O. OPSO FALL CONFERENCE PORTLAND, OR 16 SEPTEMBER 2017 OVERVIEW What are the ACC/AHA Stages of HF? What

More information

What s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital

What s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital What s New in Heart Failure? Marie-France Gauthier, BSc, PharmD, ACPR Clinical Pharmacist at Montfort Hospital Disclosures I have no current or past relationships with commercial entities Learning objectives

More information

CKD Satellite Symposium

CKD Satellite Symposium CKD Satellite Symposium Recommended Therapy by Heart Failure Stage AHA/ACC Task Force on Practice Guideline 2001 Natural History of Heart Failure Patients surviving % Mechanism of death Sudden death 40%

More information

CT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD

CT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD CT Academy of Family Physicians Scientific Symposium October 2012 Amit Pursnani, MD Clinical syndrome resulting from a structural or functional cardiac disorder that impairs the ability of the heart to

More information

Heart Failure Management Policy and Procedure Phase 1

Heart Failure Management Policy and Procedure Phase 1 1301 Punchbowl Street, Harkness Suite 225 Honolulu, Hawaii 96813 Phone (808) 691-7220 Fax: (808) 691-4099 www.queenscipn.org Policy and Procedure Phase 1 Policy Number: Effective Date: Revised: Approved

More information

Performance and Quality Measures 1. NQF Measure Number. Coronary Artery Disease Measure Set

Performance and Quality Measures 1. NQF Measure Number. Coronary Artery Disease Measure Set Unless indicated, the PINNACLE Registry measures are endorsed by the American College of Cardiology Foundation and the American Heart Association and may be used for purposes of health care insurance payer

More information

Heart Failure. Dr. William Vosik. January, 2012

Heart Failure. Dr. William Vosik. January, 2012 Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment

More information

Heart Failure Update John Coyle, M.D.

Heart Failure Update John Coyle, M.D. Heart Failure Update 2011 John Coyle, M.D. Causes of Heart Failure Anderson,B.Am Heart J 1993;126:632-40 It It is now well-established that at least one-half of the patients presenting with symptoms and

More information

Target dose achievement of evidencebased medications in patients with heart failure with reduced ejection fraction attending a heart failure clinic

Target dose achievement of evidencebased medications in patients with heart failure with reduced ejection fraction attending a heart failure clinic Target dose achievement of evidencebased medications in patients with heart failure with reduced ejection fraction attending a heart failure clinic June Chen 1, Charlotte Galenza 1, Justin Ezekowitz 2,3,

More information

Incidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction

Incidence. 4.8 million in the United States. 400,000 new cases/year. 20 million patients with asymptomatic LV dysfunction Heart Failure Diagnosis According to the Working Group in Heart Failure, CHF is a syndrome where the diagnosis has the following essential components: A combination of: Symptoms, typically breathlessness

More information

Heart Failure. Dr. Alia Shatanawi

Heart Failure. Dr. Alia Shatanawi Heart Failure Dr. Alia Shatanawi Left systolic dysfunction secondary to coronary artery disease is the most common cause, account to 70% of all cases. Heart Failure Heart is unable to pump sufficient blood

More information

Outline. Chronic Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.

Outline. Chronic Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G. Chronic Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center Scientific

More information

Inverclyde CHP Protected Learning Event- Heart Failure

Inverclyde CHP Protected Learning Event- Heart Failure Inverclyde CHP Protected Learning Event- Heart Failure 14:00 14:05 14:05 14:20 14:20 14:30 14:30 15:10 15:10 15:30 15:30 15:50 15:50 16:05 16:05 16:35 Welcome & Introduction Paul Forsyth (HF Pharmacist)

More information

I have no disclosures. Disclosures

I have no disclosures. Disclosures I have no disclosures Disclosures What is Heart Failure? Heart Failure (HF) A complex clinical syndrome where patients present with symptoms (i.e. dyspnea, fatigue, fluid retention) that result from any

More information

Heart Failure 101 The Basic Principles of Diagnosis & Management

Heart Failure 101 The Basic Principles of Diagnosis & Management Heart Failure 101 The Basic Principles of Diagnosis & Management Bill Tran, MD Non Invasive Cardiologist February 24, 2018 What the eye does not see and the mind does not know, does not exist. DH Lawrence

More information

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G. Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Congestive Heart Failure Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014

More information

LCZ696: LA NUOVA RIVOLUZIONE NELLA TERAPIA DELLO SCOMPENSO CARDIACO. Dario Leosco Università di Napoli Federico II

LCZ696: LA NUOVA RIVOLUZIONE NELLA TERAPIA DELLO SCOMPENSO CARDIACO. Dario Leosco Università di Napoli Federico II LCZ696: LA NUOVA RIVOLUZIONE NELLA TERAPIA DELLO SCOMPENSO CARDIACO Dario Leosco Università di Napoli Federico II Projected changes in cardiovascular diseases CVD Deaths Increase 33% CVD DALYS 22% CAD

More information

Heart Failure New Drugs- Updated Guidelines

Heart Failure New Drugs- Updated Guidelines Heart Failure New Drugs- Updated Guidelines Eileen Handberg, PhD, ANP-BC, FAHA, FACC Professor of Medicine Division of Cardiovascular Medicine University of Florida Disclosures 1. 3 2. 6 3. 8 4. 11 Dunlay

More information

Congestive Heart Failure 2015

Congestive Heart Failure 2015 Definition Congestive Heart Failure 215 JP Mehegan/ Mercy Cardiology n Cardiac failure; Congestive heart failure; Chronic heart failure (synonyms) n When the heart is unable to pump sufficiently and at

More information

Drugs acting on the reninangiotensin-aldosterone

Drugs acting on the reninangiotensin-aldosterone Drugs acting on the reninangiotensin-aldosterone system John McMurray Eugene Braunwald Scholar in Cardiovascular Diseases, Brigham and Women s Hospital, Boston & Visiting Professor, Harvard Medical School

More information

Heart Failure. Jay Shavadia

Heart Failure. Jay Shavadia Heart Failure Jay Shavadia Definition Clinical syndrome characterized by: Symptoms: breathlessness at rest or on exercise, fatigue, tiredness or ankle swelling AND Signs: tachycardia, tachypnea, pulmonary

More information

Heart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid

Heart failure. Failure? blood supply insufficient for body needs. CHF = congestive heart failure. increased blood volume, interstitial fluid Failure? blood supply insufficient for body needs CHF = congestive heart failure increased blood volume, interstitial fluid Underlying causes/risk factors Ischemic heart disease (CAD) 70% hypertension

More information

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center

More information

LXIV: DRUGS: 4. RAS BLOCKADE

LXIV: DRUGS: 4. RAS BLOCKADE LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations

More information

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G.

Chronic. Outline. Congestive^ Heart Failure: Update on Effective Monitoring and Treatment. Heart Failure Epidemiology. Michael G. Chronic Congestive^ Heart Failure: Update on Effective Monitoring and Treatment Michael G. Shlipak, MD, MPH Professor of Medicine, UCSF Chief, Division of General Internal Medicine, SFVA Medical Center

More information

Review Article. Pharmacotherapy of Heart Failure with Reduced LVEF. Sachin Mukhedkar, Ajit Bhagwat

Review Article. Pharmacotherapy of Heart Failure with Reduced LVEF. Sachin Mukhedkar, Ajit Bhagwat Review Article Vidarbha Journal of Internal Medicine Volume 22 January 2017 Pharmacotherapy of Heart Failure with Reduced LVEF 1 2 Sachin Mukhedkar, Ajit Bhagwat ABSTRACT Heart failure with reduced ejection

More information

Congestive Heart Failure or Heart Failure

Congestive Heart Failure or Heart Failure Congestive Heart Failure or Heart Failure Dr Hitesh Patel Ascot Cardiology Group Heart Failure Workshop April, 2014 Question One What is the difference between congestive heart failure and heart failure?

More information

Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update)

Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update) Chronic heart failure: management of chronic heart failure in adults in primary and secondary care (partial update) NICE guideline Apendix C The algorithms Draft for consultation, January 2010 Chronic

More information

Disclosures. Overview. Goal statement. Advances in Chronic Heart Failure Management 5/22/17

Disclosures. Overview. Goal statement. Advances in Chronic Heart Failure Management 5/22/17 Disclosures Advances in Chronic Heart Failure Management I have nothing to disclose Van N Selby, MD UCSF Advanced Heart Failure Program May 22, 2017 Goal statement To review recently-approved therapies

More information

Medical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011

Medical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College

More information

2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much?

2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much? 2017 CCS HF Guidelines Medical Therapy for HFrEF When What Order and How Much? Dr. Shelley Zieroth University of Manitoba @ShelleyZieroth @CanHFSociety Disclosures Consulting/Advisory Board: Amgen, Astra

More information

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017

Disclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies

More information

Heart Failure. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none

Heart Failure. Disclosures. Objectives: 8/28/2017. This is not a virus. It doesn t go away. none Heart Failure This is not a virus. It doesn t go away Shelley Wojtaszczyk, FNP-C, CHFN Heart Failure Program Coordinator Mercy Hospital of Buffalo none Disclosures Objectives: Defining and identifying

More information

HFpEF. April 26, 2018

HFpEF. April 26, 2018 HFpEF April 26, 2018 (J Am Coll Cardiol 2017;70:2476 86) HFpEF 50% or more (40-71%) of patients with CHF have preserved LV systolic function. HFpEF is an increasingly frequent hospital discharge. Outcomes

More information

Heart Failure Management Update

Heart Failure Management Update Heart Failure Management Update Rafique Ahmed, MD, PhD, FACC, FCPS Consultant Cardiac Electrophysiologist Baltimore, Maryland, USA Heart Failure - Definition The situation when the heart is incapable of

More information

DISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE

DISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION Lori M. Tam, MD Providence Heart Institute DISCLOSURES NONE 1 OUTLINE Systolic vs. Diastolic Heart Failure New

More information

HEART FAILURE. Study day November 2018 Sarah Briggs

HEART FAILURE. Study day November 2018 Sarah Briggs HEART FAILURE Study day November 2018 Sarah Briggs Overview and Introduction This course is an introduction and overview of heart failure. Normal heart function and basic pathophysiology of heart failure

More information

Heart Failure Medications: Who Needs What Drug Now? Disclosures

Heart Failure Medications: Who Needs What Drug Now? Disclosures Heart Failure Medications: Who Needs What Drug Now? Simon Jackson MD FRCPC MMedEd Professor of Medicine (Cardiology) Dalhousie 1 Disclosures Honoraria and educational grants from: Actelion (medications

More information

2/15/2017. Disclosures. Heart Failure = Big Problem. Heart Failure Update Reducing Hospitalizations and Improving Patient Outcomes 02/18/2017

2/15/2017. Disclosures. Heart Failure = Big Problem. Heart Failure Update Reducing Hospitalizations and Improving Patient Outcomes 02/18/2017 Heart Failure Update Reducing Hospitalizations and Improving Patient Outcomes 02/18/2017 Julio A. Barcena, M.D. South Miami Heart Specialists Disclosures I have no relevant commercial relationships to

More information

HEART FAILURE. Study day November 2017 Sarah Briggs and Janet Laing

HEART FAILURE. Study day November 2017 Sarah Briggs and Janet Laing HEART FAILURE Study day November 2017 Sarah Briggs and Janet Laing Overview and Introduction This course is an introduction and overview of heart failure. Normal heart function and basic pathophysiology

More information

Cardiovascular Pharmacotherapy

Cardiovascular Pharmacotherapy Cardiovascular Pharmacotherapy Overview Mechanism of cardiovascular drugs Indications and clinical use in cardiology Renin-Angiotensin Inhibitors: Angiotensin-Converting Enzyme Inhibitors, Angiotensin

More information